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Etomidate, alfathesin and thiopentone as induction agents for coronary artery surgery

1980; Springer Nature; Volume: 27; Issue: 4 Linguagem: Inglês

10.1007/bf03007454

0008-2856

J. Tarnow, Wolfgang Heß, W Klein,

Hemodynamic Monitoring and Therapy

In 24 premedicated patients about to undergo coronary artery bypass surgery, anaesthesia was induced with either etomidate 0.3 mg kg-1, alfathesin 0.07 ml kg-1 or thiopentone 3.0 mg · kg-1, in combination with fentanyl. Detailed haemodynamic studies were made including measurements of arterial pressure, right atrial pressure, pulmonary artery and pulmonary capillary wedge pressure, heart rate, cardiac output and monitoring of the lead V5 electrocardiogram. Cardiovascular data were recorded in the awake patient and one, three and five minutes after induction of anaesthesia. Following fentanyl 0.01 mg · kg-1 and suxamethonium 1.0 mg · kg-1 the trachea was intubated and further measurements were made immediately and five minutes after intubation. Induction of anaesthesia using the new non-barbiturate agent etomidate was associated with a remarkable cardiovascular stability. No major changes in heart rate, arterial blood pressure, cardiac index, pulmonary artery pressure, right and left ventricular filling pressure or total peripheral resistance occurred. The addition of fentanyl decreased heart rate and cardiac index slightly and was associated with a significant reduction of the rate-pressure product. The cardiovascular effects of thiopentone were very similar to those of etomidate, except for a small increase in heart rate with thiopentone. Alfathesin produced a significant fall in arterial pressure, cardiac index and stroke index, while heart rate increased. The rate-pressure product remained unchanged. The combination of alfathesin with fentanyl produced an additional decrease in blood pressure and cardiac index. None of the three induction procedures was associated with cardio-vascular stimulation during laryngoscopy and tracheal intubation. Our findings suggest that either thiopentone or etomidate combined with fentanyl are acceptably safe in cardiac patients while alfathesin with fentanyl appears to be more detrimental to the circulation.